Medical Travel

by Steven Lash
Minorities make up more than one-third of the United States population, according to the Census Bureau. By 2050, ethnic Americans are expected to represent close to half of the U.S. population.
Among the fastest-growing ethnic populations are Hispanics and Asian Americans (including Asian Indians). In the next 25 years, more than half of the U.S. workforce will be of second and third generation descent. A large share of the labor force is comprised of Hispanics, Filipinos, Asian-Indians, Vietnamese, and Chinese employees. Companies with largely diverse workforces have a vested interest in meeting the health and welfare needs of their employees and being responsive to these cultural ties. Implementing a global medical travel program can be an attractive option for the growing number of minorities in the United States.

Why Medical Travel Appeals to Ethnic Populations

Medical travel, also commonly referred to as “medical tourism” or “global healthcare,” is the practice of traveling across international borders to get healthcare. As many as 750,000 Americans went outside the United States for healthcare in 2007, including dental procedures, according to a 2009 Deloitte survey. That number is expected to grow to 1.6 million by 2012 with a sustainable annual growth rate of 35%.

Travelers typically seek common elective, but specialized surgical procedures, such as joint replacement, cardiac, bariatric, cosmetic, and major dental work.
The most popular destinations for medical travel include Mexico, India, and Thailand. Moreover, the survey revealed that there is a strong interest in medical tourism in selected ethnic populations. Asians and Hispanics had the greatest desire at 56.8% and 51.4%, respectively, when asked if they would consider having surgery outside the United States. There are many reasons why ethnic minorities would take advantage of medical travel. One is the fact that that they have lived in their home country or still have family and friends living there. If they go back several times a year to visit, it may be convenient to have a procedure while they are abroad. Ethnic minorities who have ties to their home country do not have to struggle with cultural or language barriers.

The Benefits of Global Healthcare

Medical travel has gotten much more popular over the past few years and will continue to grow as U.S. healthcare costs rise and employers shift more costs onto their employees. A big reason why medical travel is gaining appeal is that it can significantly reduce healthcare costs. Employers save an average of 40% to 80% for international surgical procedure compared to U.S. costs. That savings is realized even after factoring in all travel costs (hotel and airfare) for the patient and travel companion. The 40% to 80% savings equates to tens of thousands of dollars on a single procedure, making medical travel an obvious option for businesses and employees to explore. Many medical travel programs do not charge a per-employee/per-month fee or a network access fee. There is no need to invest up-front dollars in the medical travel program since savings are based on utilization.

Many high quality hospitals, physicians, and medical services are available globally. There are more than 300 Joint Commission International (JCI)-accredited organizations in 39 countries; many have quality standards that rival leading U.S. hospitals. These institutions are staffed by U.S./U.K. or equivalently trained and board certified physicians and registered nurses who speak English. Many are also affiliated with some of the most respected medical providers in the U.S., such as Johns Hopkins, Harvard Medical, and the Cleveland Clinic. They offer state-of-the-art medical equipment and techniques, spacious private rooms with modern amenities, as well as excellent patient care and quality outcomes.

While the cost of getting care internationally is significantly lower than in the U.S., patients still have access to some of the best care in the world. As the minority population continues to grow each year and more employees express a desire to return to their home country for healthcare, progressive insurance plans and self-funded employers will incorporate medical travel programs to meet the needs of their culturally diverse workforce.
––––––––––Steven Lash, president & CEO of Satori World Medical, is a seasoned healthcare executive and entrepreneur. He has more than 25 years of healthcare experience, including 19 years at Sharp HealthCare, San Diego’s largest healthcare delivery system. Satori World Medical provides access to its global network of board-certified doctors and worldwide centers of excellence through an integrated program, which is easily added to any health plan. For more information about Satori World Medical, call 619-704-2000 or visit at http://www.satoriworldmedical.com.

Increase Your Closing Rate With Transactional Life Insurance

by Greg Schwabe, FLMI
Building relationships is everything for the life insurance producer. It’s the only way to serve a client’s best interests over time. It takes work to establish credibility and earn a client’s trust.

Yet, all situations are not identical. For example, you may spend much of your time on smaller cases that come back with higher than applied for offers and with clients who want to appeal the decision or have you look for a better offer with another carrier. This exercise only extends the time it takes to place the business, sometimes endlessly, if it doesn’t end up jeopardizing the sale. You invest time and effort and have nothing to show for it.

Is underwriting taking six to 10 or more weeks for too many of your life insurance cases and then another two-to-four weeks before the policy is finally placed? There are ways to avoid that long road that, all too often, winds up in a dead end.

The longer it takes to close a case, the greater chance there is for something to nix it. And that happens. The client may have a doctor’s visit that uncovers a medical condition that didn’t exist at the time of the application, but could affect the underwriting. In the worst possible scenario, the client may die before the underwriting process can be completed.

Even though you’ve seen it happen, you still say to yourself, “Yes, but this one will be different,” and then, it isn’t.
You may recall hearing the statistic that for every day beyond the application date, the probability of placing the case goes down by 1%. Even more frustrating is finding out that all the effort you put forth, once the case is finally placed, generates a $500 to $1000 annualized premium and perhaps even less.
The challenge is to develop new business that flows quickly through the underwriting pipeline, provides larger commissions, and minimizes the likelihood of generating another application on the same client.

One task is to minimize the obstacles in order to get the best possible shot at closing the case. This includes doing some basic field underwriting by asking basic medical questions so there’s less of a chance that an underwriter will come back and request additional information.

A red flag should go up when you’re meeting with a client to review a sales ledger, run at the best underwriting class, and you see him popping three or four prescription drugs. Always give clients a realistic expectation of what the proposed coverage is going to cost. Set the bar low enough so that you can under promise and over deliver. This is the best way to avoid the embarrassment of having to go back to a client.

Here’s another strategy for avoiding delays: When a case comes back from underwriting as standard, for example, rather than as preferred as applied for, the change may be more palatable to the client by showing that the premium is unchanged, although the face amount has been reduced somewhat.
Solution: The opportunity is to promote products and ideas that lead to transactional sales, especially those that don’t involve taking disposable income out of a client’s pocket. Wealth transfer of idle assets leads to transactional sales. Included in the idle-assets category are Money Market accounts, CDs, annuities, excess savings, mutual funds, or anything else that a client is waiting to pass on to heirs or have available in case of a catastrophic medical event or emergency.

The first step is to identify assets that will not be needed to supplement retirement income. And just about every client has them. The objective is to reposition these funds so they work harder for your clients. The goal is to give them an income tax-free benefit for an asset that is otherwise taxable at death. A few simplified issue plans will offer a benefit that is roughly double the size of the deposit, which can be passed on to heirs or provide long-term care protection. They offer upwards of $5 for every $1 invested in these multi-dimensional products. If insurability is an issue, consider annuity products that offer some long-term care benefits.

Some plans can actually be underwritten at the point of sale and the advisor can leave with the application and a check to place the case and the policy to the client. For its single premium universal life product, one major carrier only asks three medical questions for the life coverage and an additional four questions for the long-term care rider.

Small Business Employee Benefits

Every advisor has small business owners as clients. In today’s economy, most business owners are looking for ways to control expenses and still provide attractive benefits to help retain their employees. They are constantly reviewing their costs, including group term life coverage, disability insurance benefits and, in some instances, even long-term care coverage. These products are sold by enrollment and require minimal underwriting time. As a reminder, it’s smart to make sure you always have a census form available when meeting with small business clients and prospects.

The Simplified Life Application Processes

Advisors should be aware of the simplified underwriting options that are now available. Many life sales can become transactional by using simplified issue products for clients who want a policy right away or for clients who are marginally standard underwriting risks.

By asking the right medical questions, up front, it’s not necessary to wait six to eight weeks for a case to be underwritten that will end up with the same premium as a product that takes only one week to process and issue.

Traditional life carriers offer new business processes that shorten underwriting time by up to two weeks. It makes life easier and quicker for clients and agents alike. These processes are ideal for smaller cases that can be conducted by telephone in a matter of minutes.

Transactional life sales don’t fit every situation. Yet, many can meet a client’s needs. By being realistic and not over-promising, you can get a policy in the client’s hands faster than your competition and exceed the client’s expectations. At a time when so many clients are in a “get it done now” mode, you can have the tools for doing just that.
––––––––––Gregory E. Schwabe, FLMI, is national marketing director for First American Insurance Underwriters, a Needham, Mass.-based insurance brokerage firm specializing in coaching successful producers. During his 25 years in the life insurance brokerage business, Schwabe has been a presenter at national meetings and has spoken at life association events and career agency offices about working in the brokerage marketplace. For more information, call 800-952-0820 or e-mail gschwabe@faiu.com.

Welcome to Our Annual 2011 HSA Survey

by Leila Morris
Welcome to our annual HSA Survey. We asked the top companies in the state essential questions about coverage and services that affect you, the broker. Read on to find out what plans will work best for you and your clients. Look For Part II of Our Annual HSA Survey in the February 2011 Edition

1. What are the primary services you offer as part of your HSA product?

Aetna: Compatible high deductible medical plan, HSA administra-
tion, HSA investment services.
Anthem Blue Cross: We offer Medical HSA Health Plans and an op-
tion to in an integrated Banking system through our contracted partners; NY/Mellon.Blue Shield: Blue Shield does not directly offer a health savings account (HSA) product, but rather has a relationship with Wells Fargo Health Benefit Services to offer HSA administration to eligible members enrolled in one of our high-deductible health plans (HDHP). Through this relationship, eligible Blue Shield members may be able to benefit from a tax-advantaged HSA with online account management, access to healthcare debit cards linked to their HSAs for qualified medical expenses, and comprehensive customer service. Although Blue Shield has a relationship with Wells Fargo, members may open their HSAs with the financial institution of their choosing.CIGNA: CIGNA Choice Fund HSA, with accounts managed by JPMorgan Chase, is an integrated HSA, combining the plan’s entire healthcare and financial management features into one easy-to-use healthcare product. It includes several features, such as health coaching, integrated medical and HSA claim capabilities, a diverse range of mutual fund choices, employee education, and medical and pharmacy cost transparency tools, hospital quality comparison tools, and online health risk assessments.First Horizon Msaver: We offer an FDIC insured health savings account that may be matched with any carrier’s qualified high-deductible health plan. Account holders receive a specially branded VISA debit card, tiered interest rates, three investment options, an award-winning CD welcome kit, no-fee ATM transactions, free bill pay online, free banking online, and a healthy lifestyles portal to help save money on prescription drugs and medical services. First Horizon Msaver also offers a dedicated HSA customer call center.HSA California: The HSA California Exchange is the only small-group, fully integrated HSA program with multiple carriers. Each employee can choose from a menu of HSA-qualified high deductible health plan benefits from Health Net, Kaiser Permanente and Western Health Advantage with no minimum participation requirements.
HSA banking and savings programs are offered through The Bancorp Bank, with accounts FDIC-insured to at least $250,000. Accounts include a free debit card, access to hundreds of investment options, personalized checks, and 24/7 secured online banking access. There are no application or set-up fees to open an HSA with The Bancorp Bank.
HSA California also offers Dental, Vision, Hearing, HR Support, Life and Section 125 POP plans along with prescription discounts through The California Rx Card Program.Kaiser Permanente: We offer health savings account (HSA) Qualified Deductible HMO plans (available to the Individual and Family market, Small, Mid, and Large employer groups), PPO plans (available to Small businesses, with 2 to 50 subscribers), EPO plans for individuals and self-funded EPO plans. We have selected Wells Fargo as our preferred financial administrator to provide HSAs in connection with our HSA-qualified health plans. Wells Fargo offers all of our customers a competitively discounted monthly administrative fee, an FDIC-insured tiered interest rate account, HSA debit cards, investment options, online account management, and dedicated customer service.
With the HSA, eligible employees set aside funds to pay for current and future qualified medical expenses on a tax-free basis. Contributions can be made to the HSA by the employee, the employer, or both. When employers contribute HSA funds they save on premiums, their HSA contributions are tax deductible, and they are providing a great incentive with which to attract and retain good employees. Our HSA provides:
• Tax savings – any funds employers contribute are tax deductible. Plus, employees can save with pretax contributions (reducing their income taxes), tax-free investment earnings, and tax-free withdrawals for qualified medical expenses
• More benefits dollars directly to employees – employers can contribute some of their premium savings directly to their employees’ HSA accounts—helping motivate them to start saving for their future health care needs
• Portable savings for employees — employees own the funds in their HSA, so the account goes with them if they change jobs, become unemployed, or switch to a new health care provider
• Easy access to funds with the Wells Fargo Visa debit card — employees can use the debit card to pay for qualified medical expenses anywhere Visa is accepted
• Discounted administrative feeSterling HSA: Sterling offers education, implementation and account
management services through personal sales and service teams, as well as online for brokers, employers and accountholders. Among our primary services are HSA education, enrollment assistance, a review of the explanation-of-benefits, bill paying, record keeping, scanning and archiving of bills, receipts, and other critical information in case of an IRS audit. We also offer options for self-directing investments and flagging expenses submitted as qualified and non-qualified for HSA distribution. Our online services include online enrollment, banking, account transaction information and the ability to make changes to the HSA account. We launched an upgraded website in 2010 with even more online transaction features and accountholders like the results. In a recent accountholder satisfaction survey, over 70% of Sterling accountholders said our online account services is one of the things they like most about what we offer. We offer services in Spanish, as well as English. In late 2010 we launched a Spanish website, including HSA online enrollment for individuals and employer groups in Spanish. We have many Spanish bi-lingual sales and customer service representatives to help our clients.UnitedHealth Group: UnitedHealthcare is the largest provider of consumer-driven health plans in the country with nearly 3 million members enrolled in consumer-driven health plans that incorporate a health savings account or health reimbursement. Additionally, UnitedHealth Group uses its own financial corporation, OptumHealthBank, for its HSA program administration. OptumHealthBank, an FDIC-insured financial institution focused solely on health care banking, is the nation’s largest HSA administrator. Account holders receive market competitive interest rates on their deposits, online bill payment options, and direct debit card access to their accounts. Additionally, once they get a qualifying account balance, they also can invest in a range of highly regarded no-fee, non-proprietary investment options.

2. Do you offer an HSA-qualifying high deductible health insurance plan?

Aetna: Yes.Anthem Blue Cross: YesBlue Shield: Yes, Blue Shield offers multiple high-deductible PPO
plans that work in conjunction with HSAs.CIGNA: Yes, CIGNA offers a full suite of account-based medical plan
designs that meet the definition of a qualified high deductible plan.
First Horizon Msaver:We do not offer an HSA-qualifying high deductible insurance plan, but our health savings account may be paired with any carrier’s qualified health plan, which allows for greater portability.HSA California: Yes, HSA California only offers HSA-qualified health
plans; our portfolio includes seven different HSA-compatible plan designs.Kaiser Permanente: Yes, we offer an array of HSA-Qualified Deductible HMO plans for the Individual, Family and Employer group markets, PPO plans for Small business groups with 2 to 50 subscribers, EPO plans for Individuals, and Self-funded EPO plans. Features include:
• The option to establish a health savings account (HSA) with our preferred administrator, Wells Fargo
• Extensive resources and tools for better decision-making and health
• Online employee account services from Wells Fargo
And, of course, members have full access to coordinated care—including primary, specialty, and hospital care, plus pharmacy and vision coverage, all linked by our integrated care delivery model. Members also have access to our industry-leading personal health record—members can log on to My Health Manager at kp.org to e-mail their doctors, refill prescriptions, check lab results, and much more.Sterling HSA: As an independent HSA administrator, Sterling can
work with all HSA compatible plans — fully insured and self-insured.UnitedHealth Group: Yes, UnitedHealthcare has partnered with OptumHealthBank for HSA administration, savings and investment opportunities.

3. Are you providing a health spending arrangement or a savings vehicle?

Aetna: Yes.Anthem Blue Cross: We have partnered with BNY/Mellon and their support staff – ASC/Mellon to provide banking and investment options for the financial piece of our HSAs. Our integration allows members to login to www.Anthem.com/.ca and be linked to their BNY/Mellon account.Blue Shield: As Blue Shield only offers the HDHPs, eligible members have the flexibility to utilize Wells Fargo’s 13 HSA mutual fund options to accommodate a range of objectives. For example, once the FDIC-insured deposit account reaches a minimum balance of $2,000, the member has the option to direct contributions above $2,000 into the investment options they choose.CIGNA: CIGNA has an extensive offering of consumer funds that include an HSA, HRA, healthcare flexible spending account, dependent care flexible spending account, and incentive health reimbursement accounts (Healthy Awards).First Horizon Msaver: We provide an FDIC insured savings account with tiered interest rates that can be linked to one of three investment options. More accounts features can be seen at firsthorizonmsaver.com.HSA California: HSA California and The Bancorp Bank have partnered to create a seamless, online approach for employers and employees to fund an HSA with a wide array of savings and investment options.Kaiser Permanente: With this plan, employers and employees can save money, promote health, and make health care decisions. With an HSA-compatible plan, members can:
• Get lower premiums and tax savings—costing less than traditional HMO plans, our HSA-compatible plans combine lower premiums with tax-advantaged features
• Choose from a flexible selection of deductible HMO plans
• Give employees full access to coordinated care—including primary, specialty, and hospital care, plus pharmacy and vision coverage, all linked by our integrated care delivery model
• Offer a wealth of preventive services—covered with low co-payments and not subject to the deductible
• Help protect employees from high costs—annual out-of-pocket limits help shield employees from high costs Members who enroll in one of our HSA-Qualified Deductible HMO plans can open a health savings account through our financial administrator, Wells Fargo. However, members are also free to open a health savings account with a financial institution of their choice. Our HSA-Qualified Deductible HMO plans are designed to work with HSA administration from any financial institution. In terms of other spending arrangements, we also offer different deductible HMO plans paired with Health Reimbursement Arrangements (HRA).Sterling HSA: Yes, in addition to HSAs, Sterling also provides admin-
istration services for HRAs, FSAs, POPs and COBRA.UnitedHealth Group: Yes, UnitedHealthcare offers several HSA-qualified HDHPs. In addition to administering the medical plan, UnitedHealthcare offers a wide variety of health care services, tools, and tips for its HSA customers.

4. What size employee group is the HSA available for?

Aetna: All sizes of groups.Anthem Blue Cross: All employee groups are eligible.
Blue Shield: We offer HSA-compatible plans for all markets, including individual and family, small groups (from two to 50 employees), midsize groups (51 to 299 employees), and large groups (300+ employees).CIGNA: Our integrated HSA product is available for employers with 51 or more eligible employees. We also offer qualified high deductible health plans.First Horizon Msaver: We provide HSA administration for individuals as well as groups of all sizes.HSA California: HSA California is available for employers with 2-50 employees.Kaiser Permanente: We offer HSA-Qualified Deductible HMO plans to any group size. PPO plans are available to groups with 2 to 50 subscribers, and Self-funded EPO plans are available to groups with 500 subscribers.Sterling HSA: We work with groups of all sizes, including large, medium and small employers. We also work with individuals, many of whom sign up for our HSA online.UnitedHealth Group: Yes, UnitedHealthcare has partnered with OptumHealthBank for HSA administration, savings and investment opportunities.

5. Is your management team experi-enced in health insurance, financial services, or both?

Aetna: Health insurance.Anthem Blue Cross: Anthem has subject matter experts in health insurance and the financial services for our HSAs plans. These associates can work with the client and agent/broker to explain all processes.Blue Shield: Blue Shield’s management team is experienced in healthcare services, but works closely with Wells Fargo, as our preferred HSA administrator, to ensure effective coordination with the financial services involvedCIGNA: Our CIGNA Choice Fund HSA product combines the expertise of CIGNA’s management team (health insurance) and JPMorgan Chase (financial services) to offer an integrated solution for our customers.First Horizon Msaver: Our management team is experienced in both health insurance and financial services.
HSA California: The HSA California team is comprised of health insurance specialists with extensive experience with both HDHPs and HSAs. Our banking partner, The Bancorp Bank, provides expert financial services support via a team that shares 140-plus years in banking and technology experience.Kaiser Permanente: Our management team is experienced in health insurance and HMO plans. Our HSA administrator, Wells Fargo, brings the appropriate financial services expertise.Sterling HSA: Sterling HSAs executive team has extensive experience in Healthcare, insurance, and consumer directed account management. We have complemented those skills with staff and advisory board members who have experience in financial services to optimize support of our clients during enrollment and to manage their accounts with us long-term.UnitedHealth Group: Both.

6. Do you provide training for brokers about HSAs?

Anthem Blue Cross: We provide ongoing broker communications, newsletters, and product demonstrations as new products are introduced.Blue Shield: Yes, Blue Shield provides a continuing education seminar on HSAs to our IFP brokers periodically. Brokers also have access to educational programs and tutorials through Wells Fargo.CIGNA: CIGNA provides consumerism education on products including the HSA to brokers via forums, newsletters, collaterals, and through highly skilled sales managers.First Horizon Msaver: We provide CE certified training programs on the subject of HSAs in over 20 states. In addition, First Horizon Msaver regional representatives and the Broker Support Team (1-866-889-8583, Option 3) are available to assist brokers in the field with education as well as the installation and enrollment of the HSA.HSA California: Yes, HSA California has dedicated HSA experts ready to provide personalized training and HSA education to brokers. We can be reached between 8 a.m. and 5 p.m. Monday-Friday at sales@hsacalifornia.com or toll-free at 866.251.4625. HSA California also provides ongoing seminars to provide brokers with the information and tools they need to explain High Deductible Health Plans and HSAs to clients.Kaiser Permanente: Yes, we provide training to our brokers. In addition, our HSA financial administrator, Wells Fargo, has a dedicated support line to assist our brokers with questions. Wells Fargo also has an online flash educational presentation for our customers about HSAs online at: wellsfargo.com/investing/hsa/demoSterling HSA: Yes, Sterling offers a variety of training options, including CE courses across the nation, webinars, “lunch and learn” meetings for large regional brokerage groups, and individual sessions pairing Sterling account executives with brokers and consultants.UnitedHealth Group: Yes, we routinely provide training to brokers on all of our products and services, including print materials, online education, and regular webcasts to inform brokers about the HSA.

7. What commissions are paid to brokers and when?

Aetna: Standard commission levels, monthly.Anthem Blue Cross: Brokers are paid the standard medical commission for the HSA compatible medical plan.Blue Shield: Blue Shield does not pay commissions for HSAs because we administer the HDHP; however, financial institutions charge variable HSA referral fees.CIGNA: CIGNA pays its standard commissions for HSA sales.First Horizon Msaver: We pay brokers $.50 per account referred for the life of the account. Referral fees are paid via direct deposit on a quarterly basis. More information about how First Horizon Msaver works with brokers may be found at firsthorizonmsaver.com.HSA California: HSA California pays standard commissions monthly.Kaiser Permanente: Brokers are paid the standard medical commissions for all of our HSA-qualified health plans. For more information, please visit brokernet.kp.org.Sterling HSA: Commissions for our HSA business are 10% of the fees or all new and renewing groups and are paid quarterly. We also pay commissions on HRA and FSA business.UnitedHealth Group: UnitedHealthcare’s standard commission schedules and payment processes apply to the CDH products.

8. Are electronic enrollment forms accessible through your Website?

Aetna: Yes.Anthem Blue Cross: Yes.Blue Shield: Employees enrolling in a Wells Fargo health savings account (HSA) through their employer are able to conveniently enroll online directly with Wells Fargo. Enrolling online eliminates the need to complete and mail in paper enrollment forms, provides an efficient enrollment process that is accurate and secure, and delivers immediate enrollment confirmation to employees.CIGNA: CIGNA provides an online and paper version of the HSA bank enrollment application. Employers can provide online or paper enrollment options for their employees.First Horizon Msaver: We were first to market with a completely paperles online enrollment form. Brokers and employers are encouraged to call the Broker /Employer Support Center (1-866-889-8583, Option 3) to obtain an enrollment form URL that is exclusive to the group and the broker. Other electronic enrollment methods are available for large groups. A generic online enrollment form may be found at http://www.firsthorizonhsa.com.HSA California: PDF enrollment forms are available on our Web site at www.hsacalifornia.com. Employers and employees can open and fund an HSA on our Web site through a simple process driven by our partner, The Bancorp Bank. Employers can even maintain employees’ membership information online.Kaiser Permanente: Individuals and Families can apply for our health plans online by logging on to: kaiser.healthinsurance-asp.com/expressweb/user/Welcome.action
Health plan enrollees whose employer is not sponsoring an HSA and individuals enrolled in our Individual and Families health plans can open and fund an HSA account online at: wellsfargo.com/investing/hsa/enroll.Sterling HSA: Yes, we provide online enrollment for individuals who are part of employer groups, individuals seeking a HSA administrator on their own, and for employer groups to manage the HSA enrollment of employees.
Sterling account enrollment and management forms are also available on our website at www.sterlinghsa.com to download, print, and email or mail to us. Again, our online enrollment and paper forms are available in English and Spanish.UnitedHealth Group: Yes, electronic enrollment forms are available through our Website.

9. How do you assist account holders with paying medical bills?

Aetna: We provide cost estimator and quality assessment tools.Anthem Blue Cross: High Deductible Health Plans engage the members to be knowledgeable about their healthcare treatment and management of funds.
Members manage their own bank accounts, pay for their medical and Rx needs with their HSA account. Members can view online their banking balances and their claim activity.
Account status and explanation of benefits documents are available through our Website.
Members can use their debit card or Mellon checks to pay for their out of pocket responsibility. The customer service advocates are available to help members understand their financial responsibility.Blue Shield: As a health plan, Blue Shield determines plan eligibility and payment for services incurred, such as determining plan and member responsibility based on plan agreements. The member is responsible for determining which qualified medical expenses they choose to pay out of the HSA. Any HSA financial transactions (movement of money into and out of the HSA regardless of qualified medical expenses status) are managed by the HSA trustee or custodian.CIGNA: CIGNA helps account holders manage their healthcare expenses with information decision support tools and ready access to HSA funds through a single sign-on from our website, mycigna.com. Customers with the CIGNA Choice Fund HSA have access to their HSA dollars via a debit/ATM card, online bill payment functionality, and paper checks. CIGNA also has an auto-claim forward option available for individuals, creating an automatic withdrawal from their HSA for out-of-pocket medical expenses. The auto-claim forwarding deepens the integration of the CIGNA Choice Fund HSA by including the HSA balances and payments into the individuals Explanation of Benefits (EOB), Quicken for Health Expense Tracker, Health Statement, and Treatment Cost Estimator.First Horizon Msaver: We offer free Online Bill Pay for the convenient electronic payment of medical bills. Tools such as a free medical cost estimator and a patient bill evaluation and negotiation service are also available in the Healthy Lifestyles Portal at www.firsthorizonmsaver.com.HSA California: Our carrier partners – Kaiser Permanente, Health Net, and Western Health Advantage – have created special units within their organizations to help members enroll in HSA California.Kaiser Permanente: Money in the HSA can be used to pay for a variety of healthcare-related expenses ranging from routine physicals to prescription drugs. To pay for expenses, the member can simply present their HSA debit card to the provider, and money will be deducted directly from their HSA. However, if the member wants to pay for services out of pocket and submit an HSA reimbursement claim manually, they can. Members can contact our Member Services department with any medical bill question or concerns.Sterling HSA: Sterling reviews the explanation of benefits and medical bills for health plan discounts to insure that our accountholders do not spend more for a healthcare service or product than the insurance company would pay. We also alert accountholders when we spot disbursements that do not appear to comply with IRS rules. We help our clients with payment plans to their providers in the event there are insufficient funds to pay a bill. We also partner with Medical Cost Advocate to help our accountholders negotiate medical costs before and after they are incurred.UnitedHealth Group: Participants can use checks or a debit card to
access funds in their HSA to pay providers directly for outstanding expenses or reimburse themselves for out-of-pocket expenses paid to a provider. UnitedHealthcare then gives members monthly health statements that provide personalized cost-saving and health improvement tips, as well as simple charts showing individuals’ claims experience and health care account balances – all in an easy, concise, plain-English sort of way.

10. How does the administrator help the accountholder with insurance-related questions?

Aetna: Customer service representatives are available by phone and and through our website.CIGNA: CIGNA offers integrated customer service via our mycigna.com Website and 24/7/365 toll-free telephone service to respond to questions about the member’s health insurance and the HSA.Anthem Blue Cross: Anthem provides online resources as well as a customer service support line for all members. Support numbers are listed on the member’s health insurance card.Blue Shield: All HDHP-related questions are referred back to Blue Shield.HSA California: Both HSA California and The Bancorp Bank have customer support teams with expert knowledge available by phone or e-mail from 8 a.m. to 5 p.m. Monday-Friday.First Horizon Msaver: We work with a large number of health plans and will refer the account holder to the health plan for questions related to insurance. However, general HSA questions can be answered by the dedicated HSA call center staff.Kaiser Permanente: Our preferred financial administrator for HSAs, Wells Fargo, refers insurance-related calls back to Kaiser Permanente. Our member service representatives are trained to answer any insurance related questions members may have. Additionally, at kp.org/deductibleplans members can educate themselves about what to expect pre/during/post visits with our providers, including decision support tools (e.g., preventive services list, sample fee list, interactive treatment fee tool) that may facilitate better understanding of their insurance coverage and optimize the wide range of health-related services we offer.Sterling HSA: Our customer services representatives are available Monday – Friday from 6 am to 8 pm Pacific time. Clients and brokers can reach us toll-free at 800-617-4729 and via e-mail at customer.service@sterlinghsa.com.UnitedHealth Group: UnitedHealthcare’s Customer Care Professionals are available by phone to respond to all insurance and account-related questions; a number of resources, including calculators and FAQs are also available online at www.myuhc.com.

11. Is the administrator integrated with the health plan?

Aetna: YesAnthem Blue Cross: Yes, BNY/ Mellon provides consumers with:
• Online Checking Activation Services through Anthem.com/ca
• Interest-bearing checking account
• Anthem-branded MasterCard debit card
• Checkbook
• Consumer receives the HSA debit card, checkbook, etc. after completing the activation process
• Online Monthly HSA Statements (bank statement)
• Annual Tax forms: 1099s (January), 5498s (May)
• Online Investment opportunities through its subsidiary Dreyfus
• New in 2011, Online Bill Pay for the members medical feesBlue Shield: No, as members may open their HSAs with any financial in-
stitution they choose, despite Blue Shield’s relationship with Wells Fargo, the financial services and health plan services are not integrated at this time.CIGNA: Yes, the high deductible health plan is fully integrated
with the HSA.HSA California: HSA California is completely integrated with The Bancorp
Bank. Eligibility is automatically transferred to The Bancorp Bank so that account set-up is simplified; employers can set-up employee HSAs, fund employee HSAs, and complete other administrative capabilities – all online.Kaiser Permanente: No, the administrator is not integrated with
the health plan. Health plan services are provided by Kaiser Permanente, while HSA accounts are set up and maintained by Wells Fargo, our financial administrator for HSAs.Sterling HSA: We are an independent administrator available to work with all health plans across the nation.UnitedHealth Group: Yes, in 2002, UnitedHealth Group chartered
OptumHealthBank to help advance the growing convergence of healthcare and financial services and to give consumers a more integrated experience.

12. Are investment choices limited by the administrator?

Aetna: The administrator provides a diverse fund selection by asset classes supporting a range of investment objectives.Anthem Blue Cross: There are over 20 investment opportunities Through BNY/Mellon’s subsidiary Dreyfus.
Blue Shield: Yes, Wells Fargo has 13 HSA mutual fund options available.CIGNA: CIGNA offers a customized slate of diversified HSA invest-
ment options through JP Morgan Chase as part of our CIGNA Choice Fund HSA. All funds are available to HSA investors at net asset value with no front or back end loads.HSA California: The Bancorp Bank offers an extensive investment portfolio, from FDIC-insured savings accounts to more than 6,500 investment options. There are no application or set-up fees required to open an HSA with The Bancorp Bank.
Kaiser Permanente: The Wells Fargo HSA offers both an FDIC-insured interest bearing deposit account plus the option to direct funds into pre-selected investments and mutual funds. For more information on Wells Fargo Advantage Funds, visit wellsfargo.com/advantagefunds or call 800-222-8222.
However, members are also free to open a health savings account with a financial institution of their choice.Sterling HSA: Not at all. Our accountholders can choose any IRS qualified investment for their HSA funds, including stocks, bonds, mutual funds, and CDs.
UnitedHealth Group: Optum Health-Bank offers a range of highly regarded ed no-fee, non-proprietary investment options to HSA accountholders.

13. What forms are needed to submit an HSA case?

Aetna: Aetna’s standard enrollment processes are used. There are separate medical and HSA elections. Eligibility/enrollment options are electronic batch enrollment, paper enrollment, and Web enrollment.Anthem Blue Cross: An HSA Addendum and Agreement need to be completed. The HSA Addendum captures how the Employer wants to fund their employees’ accounts. The HSA Addendum is stating you will or will not use our integrated banking option. HSA Agreement must be signed if the Employer chooses our integrated partner BNY/Mellon.Blue Shield: Forms (online or paper) vary by HSA custodian or trustee.CIGNA: CIGNA’s standard processes and forms are used for all CIGNA products including the HSA.First Horizon Msaver: We recommend that new employer groups complete an Employer Registration Form. These may be obtained at fristhroizonmsaver.com or by contacting the Broker/Employer Support Team at 1-866-889-8583, Option 3. Individuals may enroll online at firsthroizonmsaver.com.HSA California: Standard application forms are needed to submit an HSA California case. These forms are available at www.hsacalifornia.com.Sterling HSA: All that is required is a completed employer group application (for groups) and an individual accountholder application for each accountholder, along with a list bill and employer preferred form of contribution. All forms are available at www.sterlinghsa.com.UnitedHealth Group: Employers contributing to the HSA account are required to complete an employer discovery document. Individuals establishing an HSA account.

14. Do you plan to offer an HSA-eligible plan to your own employees?

Aetna: Aetna Inc. offers several HSA-eligible plans to our employees.Anthem Blue Cross: All Anthem Blue Cross and WellPoint eligible
employees ave the option to choose a Lumenos HSA plan.Blue Shield: As of January 1, 2007 Blue Shield began offering an HSA-compatible plan to our own employees.CIGNA: Yes, CIGNA has offered employees HRA and HSA plan options ssince January 2005.First Horizon Msaver: Yes, we have offered an HSA-eligible plan to our employees since 2005.HSA California: CHOICE Administrators, the company behind HSA California, CaliforniaChoice, CaliforniaChoice 51+, Kaiser Permanente Choice Solution, Contractor’s Choice, and Choice Builder, currently offers its employees access to HSA-compatible plans.Kaiser Permanente: We require our standard application and enrollment process plus additional information if Wells Fargo is utilized. Wells Fargo: A broker must complete the HSA Broker Supplement – Application for Services form and an HSA Employer Application. Copies of these applications can be found at wellsfargo.com/hsa.Sterling HSA: We have offered our employees an HSA since Sterling was founded in 2004.UnitedHealth Group: All UnitedHealth Group employees have the option of enrolling in all an HSA or HRA.

15. Are you using a trust-ee? If so, how long have you been with the trustee?

Aetna: Yes, since May 2004Anthem Blue Cross: Anthem has partnered with BNY/Mellon FDIC to offer all of your banking needs for your HSA account.
Blue Shield: Blue Shield has had a relationship in place with Wells Fargo since 2004; however, members are free to choose Wells Fargo or any other qualified trustee or custodian to administer health savings accounts.CIGNA: JP Morgan Chase has been the trustee for our CIGNA Choice Fund HSA product since January 1, 2005.HSA California: The Bancorp Bank handles the HSAs directly. The HDHP insurance plans are fully insured products from Health Net, Kaiser Permanente and Western Health Advantage.Kaiser Permanente: We first began offering HSA-Qualified Deductible HMO plans with an optional HSA through Wells Fargo in our Colorado, Georgia, and Northwest regions in 2005, Mid-Atlantic States in 2006, and California and Ohio in 2007.Sterling HSA: Sterling HSA uses CitizensTrust as our Trustee since June 2010. Our previous Trustee since 2005 was Mechanics Bank. They chose to get out of the Trustee business in 2010.UnitedHealth Group: Yes, UnitedHealthcare partners with Optum HealthBank for trustee services. UnitedHealthcare’s parent company, UnitedHealth Group, chartered OptumHealthBank in 2002 to help advance the growing convergence of health care and financial services.

Going Minimalist With Limited Medical Benefit Plans:

How the Artful Use of Limited Medical Can Put Coverage In the

Picture for Clients

by James W. Greth
New business opportunities are getting tougher and tougher to find in today’s turbulent economy. Professional agents and brokers, especially, face considerable threats to their livelihood as the health benefits market reels from the uncertainties of healthcare reform. While there is no crystal ball to help us foresee exactly how it will all play out, one thing we do know is that we

must be ready, willing, and able to champion new strategies and opportunities that help our clients find healthcare options that make sense.
The limited medical benefit plan for the small group and individual markets is one very affordable product that’s getting a lot of attention these days. These plans offer health coverage for those who cannot afford or cannot qualify for traditional comprehensive health insurance.

Like traditional health plans, most limited benefit plans cover doctor visits, prescription drugs, hospitalizations and other medical services. But unlike traditional health plans, limited benefit plans cap what the insurer will pay towards medical services. Traditional plans typically cover most medical costs, in a given year, after deductibles and co-payments are met. Some limited benefit plans, for example, may cover only a few hundred dollars a day for hospital care or medical tests or they may cover only a quarter of the costs of a prescription. The balance of the costs is billed to the consumer.

Limited medical benefit plans can play a vital role in your portfolio of products. In fact, some insurers have projected potential annual growth of 14% to 16% for sales of these products to small employers who are financially unable to offer a traditional group health plan.

Why Your Clients Need Limited Medical Benefit Plans

A record rise in the number of people without health insurance, across the nation, is fueling new debate about healthcare reform and the future of the health benefits model. A September 2010 report from the U.S. Census Bureau reveals that 50.7 million or 16.7% of workers were uninsured in 2009, due to people losing jobs, families cutting benefits to save money, and companies, of all sizes, dropping benefits because of ever-rising premiums. As businesses review their health benefit costs and strategies, brokers should be prepared to offer new ideas, including limited medical benefit plans. Here are two reasons why your clients may want to hear about them:

Reason One: A Healthcare Option That Costs Less

For decades, employers in the retail, hotel, and restaurant industries have offered limited medical benefit plans to their employees. In fact, about 1.4 million workers have group health coverage through such plans, according to the National Restaurant Association. Today, your small groups, which are particularly vulnerable to fluctuations in group health premiums, should be made aware that limited medical plans are a viable option that will allow them to continue offering health coverage to employees even in tough economic times. With limited medical benefit plans, employers can contribute to the cost of the plan for each employee without over-burdening the company’s bottom line. Employees will appreciate not being left on their own to navigate the health insurance maze and employers will feel they have done the right thing by helping to defray some of the premium costs.

Reason Two: Limited Medical Benefit Plans are Guaranteed Issue

There are few health insurance options for employees with pre-existing conditions who are not in a group health plan. An estimated 35% of applicants for traditional individual insurance are declined due to pre-existing conditions. And despite healthcare reform, many of the state pools designed for individuals with health problems are unaffordable. Limited medical benefit plans are a beacon of hope for those with pre-existing conditions because they are guaranteed issue.

The Changing World of Limited Medical Benefit Plans

In the 1990s and early 2000s, unlicensed agents, often working from call centers, sold discounted health benefit plans that were similar to limited medical benefit plans. Many of these agents misrepresented discount plans as more affordable substitutes for comprehensive health coverage. Consumers who dropped their regular health coverage for a discount plan were shocked when they realized that the plans did not provide the comprehensive coverage and benefit package they expected or needed.

But a lot has happened since those days to make limited medical benefit plans attractive to agents and clients. For example, many states instituted strict Discount Medical Program Organization (DMPO) laws and cleaned up the discount plan market. As a result, anyone who speaks with a consumer about benefits or rates today must be a licensed agent in the state in which the consumer resides. In addition, health insurers are required to train agents properly to sell their products. Such stringent oversight is having a positive effect on how limited medical benefit plans are being sold and how the buying public perceives them. Today, these viable and well-received products offer an option in helping match right product with right customer at right price.

A Valuable Product for Millions of Americans

Adding limited benefit plans to your portfolio is a win for you and for your clients. For you, it means having an additional product to make available, better allowing you to tailor your sale to each client’s needs. It greatly lessens the chance that your client will look elsewhere when their budget requires a change in strategy. It also means that you can approach prospective clients with an array of products at different price points, making you more attractive as a one-stop shop for all of their insurance needs and information.

It’s a win for your clients because limited medical benefits plans bring piece of mind to small group customers who may want to offer some kind of group health benefit despite shrinking budgets. It is also a win to individuals who cannot afford traditional health insurance or who may not qualify for it. And it lets them do so through a trusted agent whom they can count on and turn to not just for insurance, but also for answers to all of their health insurance questions.
Brokers should consider these three tips when selling limited medical benefit plans to ensure the highest possible understanding of the policy as well as a happy long-term relationship with your clients:

1. Make sure that the insurance company you are representing provides written materials with clear language and full disclosures. Be sure you are familiar with the promotional materials and policy illustrations of the companies you are selling. These are the materials your clients will be taking home with them. It is important that they are able to review and understand these materials a month or a year down the road when you may not be available to explain them.

2. Provide illustrations that clearly show the maximum benefit the insured would receive. The biggest misconceptions about limited medical benefit plans have stemmed from a lack of understanding of the caps and actual maximum benefits provided for health services. Make sure that your clients understand the maximum provisions for doctor visits, prescription drugs, hospitalizations, and expensive tests.

3. Clearly distinguish how a limited medical benefit plan is different from a comprehensive health plan. Compare and contrast how traditional health plans and limited medical benefit plans work. Explain what portion of the medical costs will be billed to the insured and what portion will be covered by the plan. It is incumbent upon brokers to disclose the facts properly so that your clients clearly understand the levels of coverage available and that they don’t confuse a limited medical benefit plan with a traditional medical plan.

During these difficult times, the more products and options you are able to make available to your clients, the less chance there is that your book of business will be at risk. Having limited medical benefit plans in your portfolio helps you expand existing relationships and build new ones. Also limited medical plans are invaluable to the consumer who has no other option. So try something new; expand your limits; and discover new business opportunities in the process. q
––––––––––James W. Greth, CLU, is president of the Word & Brown General Agency and is a nationally recognized expert in the benefits and healthcare industry. Greth oversees Word & Brown’s five sales regions throughout California, providing benefit solutions for brokers and agents in the small-group employer marketplace. Prior to joining Word & Brown General Agency in l996 as a senior sales executive, he was Director of Sales for the Western Region of Metropolitan Life.

Voluntary Benefits Update

Employees Value Voluntary Benefits

A WellPoint survey reveals that 83% of employees think more highly of employers that offer voluntary benefits, in which the employee pays all or substantially all of the premium. Nearly 90% of jobseekers say that an important consideration in accepting a job offer is whether the employer offers a full range of health benefits, including voluntary benefits. Fifty-six percent called it “very important.”
In addition, 82% of employee whose companies offer voluntary benefits say they are satisfied with their benefit offerings compared to only 30% for those working for companies that don’t offer voluntary benefits. The survey also includes the following results:
• 67% say their company offers voluntary insurance including 71% of men, 74% of workers in the Northeast, 81% of workers at large companies, and 74% workers with an average household income of $50,000 or more.
• 56% say they are knowledgeable about the voluntary insurance products offered at their companies.
• 67% of say that having their employer provide voluntary benefits would increase their productivity.
• The top reasons for employees to enroll in voluntary benefits are cost savings (54%), greater protection for their families (50%), and peace of mind (44%).
For more information, visit www.wellpoint.com.
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The Rise of the Employee Driven Benefits Model

A report by Prudential reveals the following about why voluntary benefits are becoming an integral part of employee benefit plans:
• 42% of plan sponsors that offer voluntary benefits expect employee participation to increase due to the economy.
• 63% of brokers/consultants expect the struggling economy to drive an increase employee participation in voluntary benefits.
• 39% of brokers/consultants expect a big increase in the employers’ demand for voluntary benefits in the next five years. More employees are selecting voluntary insurance benefits, perhaps as an alternative to going without coverage or purchasing coverage outside the workplace.
• 20% of plan participants have added a new voluntary coverage through their employer while only 8% dropped existing coverage.
• Two-thirds of plan participants say that offering voluntary benefits increases the value of their employers’ benefit package, compared to 59% who were surveyed last year.
More than one-third of plan participants say they would be interested in getting additional advice on the following benefits:
• 39% said critical illness insurance.
• 34% said disability insurance.
• 34% said long-term care insurance.
For more information, visit www.whopru.prudential.com.
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Voluntary Benefits of the Future

American workers say that, five years from now, voluntary benefits will be important to them, but some employers are not be hearing the message. That’s one of the findings of a white paper by Colonial Life, “Workplace Forecast: Perspectives on Benefits in the Next Five Years.” Colonial Life president and CEO Randy Horn said, “Employees clearly see the need for many types of insurance protection, especially as they get older. Employers can meet these needs without increasing costs to the company by offering additional voluntary benefits at the worksite.”
Colonial surveyed full-time employees who are enrolled in life, health or disability benefits through their employer or their spouse’s employer. Employees said the following benefits would be important five years from now:
• 82% said life insurance.
• 77% said disability insurance.
• 76% said critical illness insurance.
• 75% said accident insurance
• 61% said cancer insurance.

Thirty-four percent of workers are worried that their employer will stop offering certain benefits and 48% expect this to be a concern five years from now. Ninety-five percent of HR managers and 90% brokers expect employees to rely on workplace benefits to protect their financial futures. However, only 50% of enrollees expect their benefits to help strengthen their financial security five years from now, at least moderately, and 23% don’t expect their benefits to strengthen their financial security at all.

Eighty-two percent of those enrolled in benefits say life insurance will be important to them five years from now. However, only 61% of full-time workers have life insurance through their or their spouse’s employer. Seventy-seven percent of those enrolled in benefits say disability insurance will be important to them five years from now, but only 42% of full time workers have this coverage through the workplace.

Forty-eight percent of those who plan to be employed five years from now say that health problems will influence their insurance benefit decisions at that time.
When it comes to trends affecting the benefit landscape, HR managers rate healthcare reform as the most important event; it’s a strong second for brokers, who see the coming mass exodus of Baby Boomers as the biggest driver.

Employees are more optimistic than their employers or brokers about the role of benefits in the workplace of the future. Fifty-seven percent of employees, who are enrolled in benefits, don’t expect a change in the role their employer or their spouse’s employer takes in providing benefits. However, 42% of brokers and 37% of employers expect employers to play a smaller role in the future. The complete white paper, “Workplace Forecast: Perspectives on Benefits in the Next Five Years,” is available at coloniallife.com/Latest News.
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ING Expands Voluntary Employee Benefit Efforts

ING is expanding its marketing activities to capture more voluntary employee benefit business. ING Employee Benefits announced that it will enhance its products and underwriting offers in 2011. The company recently hired a new head of voluntary sales and strategy and three new regional directors. Ivan Gilreath, president of ING Employee Benefits said, “Voluntary benefits is an underserved segment of the market. In this challenging economic market, many employers want to offer their employees smart benefit choices that will help protect their families no matter what their life stage.”

Vision–Consumers Seek Convenient Hours for Vision Care Services

by Trace Conger
It’s no surprise that we’ve become a society that expects products and services that contribute convenience to our lives. We’re increasingly relying on smart phones to simplify tasks – from finding the nearest pharmacy and navigating to it, to relying on take-away, drive-up service at our favorite sit-down restaurant. Convenience and accessibility is everywhere.

For some vision plans, however, member accessibility is still barely an afterthought. Consumers who need to fit routine eye exams into their already-packed schedules have little choice but to take off work or school.

A recent national, independent survey, by EMI Online Research Solutions, revealed what consumers really want. Approximately 40% of eyewear consumers prefer to receive eye care services during evenings or on weekends. Nearly 25% prefer to receive care on Saturdays at locations with all-day hours. Another 12% prefer weekday evenings after 6:00 p.m., and 4% prefer Sundays.

“Accessibility for eye care patients, when they want it, should be a major point of emphasis for a vision care plan,” says Dr. John Lahr, divisional vice president of provider relations and the medical director at EyeMed Vision Care. “If a member is experiencing discomfort or needs corrective eyewear, he or she will make time to go to an eye care professional, but individuals who see well are more likely to ignore a routine eye exam if it’s not convenient to his or her lifestyle.”
The benefits of preventive vision care are completely negated when consumers elect not to seek routine care, whether they need corrective lenses or not. “Comprehensive eye exams can detect glaucoma – which has no warning signs. They can also detect and lead to treatment of cataracts and age-related macular degeneration,” he says. “Eye exams can also uncover serious non-eye-related health issues such as diabetes and hypertension.”

Besides early detection of serious eye and health conditions, accessibility to eye care can also increase productivity in the workplace. According to the American Optometric Association, a slight inaccuracy in vision correction can reduce employee productivity by 10 percent and accuracy by 40%. Yet fewer than 50% of Americans schedule eye exams as frequently as recommended.

Employees aren’t the only individuals who need to fit eye exams into hectic schedules. Today, with sports and other after-school activities, children can be as busy as parents.

According to Prevent Blindness America, one in four school-aged children has a vision problem, and only 14% of children receive a comprehensive vision examination before entering school. “Often children won’t report eye symptoms because they don’t realize their eyes are out of focus,” says Dr. Lahr. “Accessibility to eye exams for children is critical because eye problems directly impact learning. If a child is having trouble focusing on the board or easel, or difficulty reading due to a vision problem, he or she may struggle in school.”

Contemporary Plans offer Greater Accessibility
Contemporary vision benefit plans that offer a robust panel of independent providers as well as major optical retail locations give members the ability to schedule eye exams, visits for contact lenses or eyewear needs when it best fits their lifestyle. It also means members can seek treatment for immediate concerns that don’t conform to a typical work schedule.

“Imagine an individual gets something in or scratches his eye when working in the yard on the weekend,” says Dr. Lahr. “With many plans, his only option is to seek treatment at an emergency room because his provider doesn’t have weekend hours.

“A visit to the emergency room can be expensive and ineffective if they lack the instruments to magnify the front of the eye. In such cases, the medical staff won’t be able to identify and treat the true cause, but the patient will still pay emergency-room fees.”

Contemporary plans include optometrists and ophthalmologists with extended hours. They also include optical retailers with night and weekend hours. They provide access to eye doctors who are licensed to treat eye injuries and diseases when the consumer needs it, even on weekends. Having this access results in greater convenience, cost savings, and higher quality treatment compared to an emergency room visit.
––––––––––Trace Conger is a Cincinnati-based freelance commercial writer specializing in business-to-business communications. He has more than a decade of experience developing a wide variety of communication projects for large and small companies. More information about the author is available at his website, www.traceconger.com. EyeMed Vision Care is one of the nation’s leading vision benefits organizations, with 140 million lives, including more than 26 million funded members, through 7,600 employers, healthcare companies and membership organizations across the United States. EyeMed members have access to thousands of private practice and retail-affiliated doctors and dispensing locations nationwide. www.whyeyemed.com

Helping Kids See Well

Parents Value Eye Care Benefits for Their Families

by Karen M. Gustin, LLIF
It’s a surprising statistic: 10 million American kids experience vision disorders. Vision problems are the fourth most common disability and prevalent handicapping condition during childhood, according to the National Parent Teacher Association.
Education experts believe that 80% of what kids learn in the early years is visual and kids need more than 15 visual skills to succeed in reading, learning, playing sports activities and in everyday situations. Seeing 20/20 is just one of those skills, according to the American Optometric Association (AOA).

The Economics of Eye Care

Due to the financial challenges of the current recession, many employers have retained medical insurance benefits, but reduced contributions to ancillary plans, such as eye care insurance or switched to voluntary plans to provide employees with access to these benefits. Not surprisingly, parents without eye care insurance are less likely to seek care for their kids, even if there is evidence of vision impairment, according to a March 2009 study by the National Eye Institute.

The AOA reports that nearly one-third of all children have never been to an eye doctor.
Untreated vision deficiencies in children can take a large toll on their future employers’ healthcare costs, when vision problems may become more costly or serious. The cost -associated with adult vision problems in the U.S. is estimated at $51.4 million.
Employers may not realize that eye care premiums are affordable and are usually stable and consistent in pricing. The Vision Council reports that vision insurance has remained a strong-selling benefit product, even with a sluggish economy.

Evaluating Kids’ Vision

In the United States, only 32 states require school-age kids to participate in vision screening tests. Many pass with 20/20 vision. But what about those kids who do not meet the standards? The AOA discovered that 29 states do not require retesting or referrals to eye doctors for children who fail the vision screening. While a vision screening is a good tool to detect whether students can read letters 20 feet away, students may have other vision issues that are not discovered through this process, such as how their eyes work when they are reading or involved in other activities.

Undiagnosed Vision Problems

Studies by the National Institutes of Health and the National Eye Institute have discovered that more than 60% of students with learning problems have undiagnosed vision abnormalities that contribute to their difficulties. More than 50% of American parents do not know that behavioral problems can indicate that a child has vision impairment issues and that literacy issues may be linked to vision problems, reports the AOA.

Convergence insufficiency is one of the most common vision disorders that kids experience. It occurs when both eyes do not work in unison, as they should. Fortunately, the majority of these vision problems can be treated with a program of optometric vision therapy, combining in-office treatments with short daily exercises at home.

Many kids cannot identify vision problems because they have never experienced different vision and don’t know that their eyes should work differently. For others, vision changes have occurred gradually and they do not notice a change in their eyes.

Although there are often no detectable symptoms for many vision concerns, the following signs may indicate that a child has a vision problem:
• Skips lines while reading, rereads lines, or uses a finger to maintain place.
• Avoids close work.
• Holds reading material closer than normal.
• Rubs eyes frequently; complains of headaches.
• Squints or closes one eye. tilts head to one side.
• Exhibits poor reading comprehension.
• Requires extra time to complete homework.
• Reverses letters when reading, such as the letters b and d.
• Demonstrates a short attention span with reading and schoolwork.
• Has difficulty in focusing, visual tracking (following an object) or alignment and moving of the eyes after six months of age.
• Has chronic redness or tearing of the eyes.
Any one of these symptoms can be a sign of a vision difficulty, which, if left untreated, may affect a child’s performance in school and result in the misidentification of the root cause of learning problems. More seriously, without treatment, children’s vision problems can cause permanent vision loss, according to Prevent Blindness America.

Eye Examination Guidelines

Eye care professionals recommend that kids regularly participate in a comprehensive wellness examination. Review these guidelines:
• During the first year of life, babies should be screened for eye health issues during regular checkups.
• By age 3 ½, kids should have an eye health screening and visual acuity test (measuring sharpness of vision) by their doctor.
• Around age five, the doctor should perform a vision and eye alignment evaluation. If a problem is detected, the child should be referred to an eye doctor.
• After age five, routine examinations are important to identify any vision problems, especially if the child squints or complains of frequent headaches.
• Kids wearing prescription glasses or contacts should have annual checkups to screen for vision changes.

Eye Care Options

Employees are concerned about having eye care benefits that allow them to take care of the vision needs of their families. They frequently rate access to eye care benefits as a factor influencing satisfaction with their employer and job. And although many employers have limited budgets, they understand the importance of a quality workforce to the viability of their business. They recognize the value of an excellent benefit package to retain and recruit the best employees.
There are many eye-care insurance plan options available for employers and employees. Work with an insurance carrier that is interested in partnering with employers to design eye care benefits that meet their needs. Throughout the year, encourage employers to provide educational information to employees on the health and wellness value of their eye care benefits.
––––––––––Karen M. Gustin, LLIF, is senior vice president – group marketing, national accounts and block acquisitions for Ameritas Group, a division of Ameritas Life Insurance Corp. (a UNIFI Company), with headquarters in Lincoln, Neb. A leading provider of dental and eye care products and services, Ameritas Group added hearing care to its product portfolio in 2008. Gustin joined Ameritas Group in 1983. She is vice chair of the National Association of Dental Plans’ board of directors and its statistical task force, and also serves on NADP’s executive committee.

Vision Plans

Many Americans Are in the Dark About Protecting Their Eyes from the Sun

by Jeff Spahr

In the winter months, many Americans are as concerned with protecting themselves from the sun, especially when the weather is cold and people are wearing layers of clothing. But a new survey from WellPoint Inc. and Transitions Optical Inc. indicates that the majority of active Americans are unaware of the potential damage the sun can have on their eyes – and the eyes of their children – when they are outside.

Additionally, many of the survey participants were unable to identify basic facts about sun exposure on their eyes, particularly when it came to children’s increased risk of ultraviolet UV light exposure. Only 36% knew that children’s eyes are at greater risk from the effects of UV rays than adults.

According to the Vision Council, a recent cost analysis showed that eye disease healthcare expenditures can reach as much as $16 billion each year, an amount that exceeds expenditures for breast cancer $7.2 billion, lung cancer $5.6 billion, and HIV $9.4 billion. Such statistics highlight the importance of vision as a healthcare issue. Based on this evidence, consumers need to be more informed about vision protection and their options.

The survey also reveals that that 37% find it difficult to wear protective eyewear like sunglasses as much as they should. Most participants said they do not wear protective eyewear more often because they forget to bring it with them. Ninety percent said they would purchase a product that would provide a convenient and effective way to protect their eyes and their child’s eyes.

Some health plans offer vision coverage for Transitions lenses for children and adults. These kinds of protective lenses are clear, but convert to sunglasses when outdoors, depending on the intensity of UV rays, to reduce glare and protect eyes.

The lenses block 100% of UVA and UVB exposure and help protect children from extreme exposure while they are active outdoors. Eighty percent of eye damage takes place before the age of 18, making the lenses a good choice for children because they can help prevent eye diseases, such as glaucoma and cataracts later in life. Americans should find out what their health benefits cover and if they need to enroll in vision benefits.
––––––––––Jeff Spahr is staff vice president of Vision and Voluntary Services for WellPoint, Inc. WellPoint is the nation’s largest health benefits company, with approximately 34 million members in its affiliated health plans and a total of more than 69 million individuals served through all subsidiaries. WellPoint serves members as the Blue Cross licensee for California. For more information, visit www.wellpoint.com.

Annuities: Are Inflation-Protected Annuities Right for Your Clients?

After a dramatic market decline, many clients turned to fixed annuity solutions that offer greater potential for growth than do traditional fixed assets and protection from market downturns. In fact, fixed annuity sales year-to-date the third quarter of 2008 to year-to-date the third quarter of 2009 increased by 16%.
People are living longer and their retirement could last 20 to 30 years. It is becoming more and more important for retirees to address increasing life expectancies as well as the ever-changing economic climate. People are continually asking themselves the following:
• “Will my savings last the rest of my life?”
• “Will my money keep pace with inflation?”
• “What if I change my mind with my investments?
• “What happens if we have another market downfall and my money is slow to recover?

Inflation-Protected Annuities

Providers are offering solutions to these concerns through a variety of income options with differing levels of inflation-protection. Inflation-protected income annuities help address many of the questions people may have with traditional single premium immediate annuities by altering the traditional immediate annuity product design.

Many traditional immediate annuity designs have the option of adding a fixed cost of living adjustment (COLA) with a death benefit that comes in the form of a certain period or some sort of refund feature. There are also products with limited liquidity that allow the owner to advance some portion of future income.
Recent innovation in the immediate annuity design has led to income annuity products that offer guaranteed income for life with annual inflation adjustments tied to actual inflation, a death benefit, and the flexibility for people to access their money in case of an emergency. They include lifetime guaranteed annual adjustments to income that are based on changes in the Consumer Price Index-Urban (CPI) rather than a fixed COLA each year. The CPI is a program of the Bureau of Labor Statistics, which produces monthly data on changes in the prices paid by urban consumers for a representative basket of goods and services.
Some immediate annuities offer a death benefit paid in a lump sum rather than being spread over the balance of a certain period. Recent product innovation has added inflation protection to the death benefit in addition to the income payment. This kind of solution helps people address their income needs while alleviating their concerns over the loss if there is a premature death. The purchaser no longer has to worry about the immediate annuity not being the right investment because of premature death. Finally, life can take unexpected turns and many people may need access to cash in the event of an emergency or simply because their circumstances have changed. Today, there are income annuities that allow for immediate access to assets. A provider will often have annuitization options within existing deferred annuity contracts that mirror the features of the products described above. This can make it very easy for the client to move from the accumulation phase to the distribution phase when they are ready.

Income Options

Since no solution is perfect for every client, insurance carriers usually offer several income options. Many providers offer fixed and variable income options with guaranteed income for an additional fee. Some of the variable annuity solutions offer tax-efficient, guaranteed income benefits (GIB). These solutions provide a guaranteed income stream that allows clients to retain control of the assets and the investment allocations allowing growth potential of the market while providing a hedge against inflation. With the guaranteed income benefit (GIB), a client’s payments never go below the guaranteed minimum amount and will actually increase automatically every contract year if the payment increases. Customized income features can provide for more solid income growth by setting a floor guarantee. This benefit is especially important to assets that may be down due to market declines.
Providers may also offer income solutions that include a guaranteed lifetime withdrawal benefit (GLWB). These solutions address clients’ multiple needs by helping to address the challenges that clients are concerned about in retirement: inflation, longevity, future market downturns, and unexpected healthcare costs. Providers are looking to income solutions that offer GLWBs that are guaranteed to grow as clients approach their retirement date — with flexibility and control built in. This means that clients can retain full control of and access to assets. This kind of solution tends to give the client the most control over the assets. But the trade off is that a GLWB tends to provide less inflation protection.

What to Look For

Inflation-protected annuities are not for everyone. Advisors should look at several factors before recommending an income solution to their client. It’s important to understand whether the client wants to have the responsibility of managing the investment allocations. What is the client’s risk tolerance now that they are in the distribution phase? A client who may have been very willing to assume equity risk in the accumulation phase may want less exposure to market downturns in the distribution phase. How long might the client need income? A client who is not comfortable with equity risk needs to consider protecting their future purchasing power from the inflation, particularly if they will need income for an extended period.

Because income streams tend to be long term, it’s important for advisors to look at providers that have good financial ratings and overall financial strength, providers that can provide the data, materials and information to answer clients’ questions, and providers that can help the advisor build lasting relationships.
––––––––––Kris Kattmann is vice president and associate actuary for Lincoln Financial Group’s Retirement Solutions business. With more than 23 years of insurance industry experience, Kattmann’s key responsibilities include product management, product development and pricing for Lincoln’s fixed annuity product solutions. Prior to the merger of Lincoln Financial Group and Jefferson Pilot Financial, Kattmann was VP and Associate Actuary at Jefferson Pilot Financial. During her tenure at Jefferson Pilot, Kattmann helped to lead the annuity product management group in the development of fixed, indexed, and immediate annuities. She also had areas of responsibility in hedging and risk management for indexed accounts, pricing, BOLI, ALM and financial reporting.

COBRA NEWS

COBRA Premium Subsidy Helped Fewer Than Expected

The federal subsidy to help laid-off workers pay for COBRA coverage helped fewer people than expected, according to an analysis by the Employee Benefit Research Institute (EBRI). Paul Fronstin of EBRI said that these findings may mean that the number of uninsured may not fall as much as predicted when subsidies become available in 2014 under the Patient Protection and Affordable Care Act of 2010 (PPACA).

Under the American Recovery and Reinvestment Act of 2009 (ARRA), the federal government paid 65% of the premium for people who were covered under COBRA and were laid off between Sept. 1, 2008 and Dec. 31, 2009. The subsidy was available for up to nine months. Congress extended the subsidy three times with the last extension in April 2010.

Part of problem is that COBRA premiums remained unaffordable for many families even with the subsidy — $1,688 for employee-only coverage and $4,681 for family coverage. Another issue is that COBRA premiums are generally not tax deductible. In contrast, premiums for current workers’ employment-based coverage are excluded from taxable income or they reduce taxable income.

EBRI notes that there are widely conflicting estimates of how many people benefited from the COBRA subsidy, but generally there has been lower-than expected take-up of the subsidy. In August and December of 2009, Hewitt reported that COBRA enrollments went from 19% of eligible people to nearly 40%. In contrast, Ceridian found that COBRA enrollment went from 12.4% to 17.7% and Aon reported that COBRA enrollment went from 14.1% to 15.9% while Deseret Mutual said enrollment went from 5.3% to 22.5%. In May 2010, The Treasury Dept. reported that 25% to 33% of eligible unemployed workers received subsidized COBRA coverage based on a survey conducted in New Jersey.

In June 2010, the Treasury Dept. released its interim report on the program, which concluded that as many as 2 million households benefited from the COBRA subsidy during 2009 at a cost of over $2 billion. But EBRI says that this estimate is highly unlikely since the report is based on employer reporting and may include double counting. EBRI says that, if $2 billion was used to subsidize 2 million households, each household would have received an average $1,000 subsidy, which is much lower than the expected annual subsidy. Also, some people who benefited from the premium may have already elected COBRA at the time that ARRA was passed.

EBRI used the latest data from the U.S. Census Bureau’s Survey of Income and Program Participation (SIPP). For more information, visit www.ebri.org,

COBRA Health Reform FAQs

The Department of Labor’s Employee Benefits Security Admin. offers the following information on the COBRA Program under health reform:
1. Did The Patient Protection and Afford-able Care Act (PPACA) extend the time period I can have COBRA beyond 18 months? No. However, certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. People who become disabled can extend the 18-month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must have a ruling from the Social Security Administration that they became disabled within the first 60 days of COBRA continuation coverage or before. The beneficiary must provide the plan a copy of the Social Security ruling letter within 60 days of receipt, but before expiration of the 18-month period of coverage. If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage.
2. How does the new healthcare reform legislation affect my coverage under my group health plan? The new healthcare reform legislation makes many changes to employee health benefit plans. Some of the changes go into effect for the first plan year that begins on or after six months after enactment (September 23, 2010), so for calendar year plans, January 1, 2011. However, many changes do not go into effect until the first plan year beginning on or after January 1, 2014. EBSA has developed a dedicated Web page on the new health reform law – the Patient Protection and Affordable Care Act. You can also get to the dedicated web page from EBSA’s Home Page www.dol.gov/ebsa by selecting the second button on the right hand navigation bar.

Dental

Say Aaah – Seniors Open Wide for Oral Health

by Patrice P. Bergman, CEBS
The senior market bodes well for brokers who are trying to sell into this space, since this market segment is more understanding of the value that insurance brings including quality dental coverage.

Well-structured dental plans offer a clear value to Medicare beneficiaries. More than 20 years into the “keep your teeth for a lifetime” era, there is a burgeoning population of those 65 and older who want to continue good oral health along with their medical health. This segment is an under-penetrated source of new clients. Brokers who understand seniors’ dental needs can provide a great service to their clients by offering dental plans with benefits that this market segment values.

A Senior Tsunami

The first Baby Boomers reach retirement age this year; by 2030, people over 65 will represent 20% of the California population. The 65- to 84-year-old population will grow faster than any other age group over the next two decades, according to U.S. Census Bureau national projections.
A growing number of seniors will lose their employer-sponsored dental plan upon retirement and will find Medicare sorely lacking in dental coverage. Many are looking for the same level of benefits that they valued when they were working or under age 65. The Baby Boomer retirement wave presents an opportunity for selling senior medical and dental plans.

The senior tsunami is changing dentistry because seniors have a very different attitude toward oral health than did preceding generations and they are willing to put their money where their mouth is if care is available, says the American Dental Association.

“Americans of advanced age are becoming the dominant age group seeking, and able to pay for, sophisticated dental services. The blend of these services is shifting away from removable prostheses to a rising demand for restorative, periodontic, and endodontic care,” says Kenneth Shay, DDS, MS, in the Journal of Contemporary Dental Practice.

In many ways, seniors’ views on oral health are better than those of younger generations. A 2009 survey by the National Association of Dental Plans compared attitudes, behaviors, and perceptions of individuals 65 years and older to those of younger adults. It showed the following about seniors:

• They have good oral habits; seniors report better oral health habits than do their younger cohorts, such as flossing daily and having a dental check-up in the last six months.
• They are just as likely as their younger cohorts to know about the links between oral and overall health.
However, they are less likely to have dental benefits than are their younger cohorts.

Oral Longevity

Good oral health is essential to quality of life. And every tooth in the mouth plays an important role in speaking, chewing, and maintaining proper alignment of other teeth. Brokers who explain the risks associated with poor oral health as well as the benefits of good oral health can help clients make informed decisions about dental benefits.

Better dental and healthcare and water fluoridation have contributed to healthier teeth in the senior population compared to preceding generations. Many retirees will have their own teeth throughout their lives because of scientific advances in dentistry and an increasing emphasis on preventive care encouraged in most dental plans. Over the past 40 years, the rate of toothlessness among older adults has dropped 60%.

Tooth loss is the result of an oral disease and not the aging process, with periodontal, or gum disease being the number one cause of tooth loss. Nearly 25% of seniors aged 65 to 75 have gum disease.

The risk of getting periodontal disease increases as people age, as does the severity of the disease. The good news is that research suggests that this may be related to risk factors other than age. Risk factors that can make older people more susceptible include general health status, diminished immune status, medications, depression, worsening memory, diminished salivary flow, functional impairments, and a change in financial status.

By understanding the importance of preventing periodontal disease, older adults are more inclined to seek affordable dental care and get dental coverage to protect against it. While dental insurance does not guarantee perfect oral health, those with dental insurance see the dentist more often and are more likely to receive preventive care.
Healthier Teeth, Healthier Bodies

Older adults increasingly view their health in a holistic way. Brokers who cross sell dental coverage with medical coverage can tie the message of oral health and overall health in a way that makes sense to seniors from a philosophic and practical sense. There is growing evidence linking medical conditions to oral health.
Periodontal disease is linked to health concerns including increased risks of heart disease, stroke, high blood pressure, chronic kidney disease, and diabetes, diseases that strike many in their retirement years. A recent study found a new link between periodontal disease and pancreatic cancer.

Regular dental exams can also detect other health problems, such as nutritional deficiencies and oral infections. In fact, more than 90% of all systemic diseases have oral characteristics that can be detected during an oral exam, including diabetes, leukemia, cancer, heart disease and kidney disease, according to the Academy of General Dentistry poor oral health can be an indication of serious problems, so older adults who don’t get regular checkups may miss a diagnosis of serious illness that could be treated in its infancy.
Boomers Want Dental Plans With Bite

There are few competitively priced, well-designed dental plans for seniors that are on par with most employer plans. Some dental plans are offered as buy-up options to Medicare Supplement or Medicare Advantage plans, complementing their medical health coverage. A few carriers offer stand-alone dental plans for those aged 65-plus.
The three most common types of dental plans are PPOs, HMOs, and discount or fee-for-service dental plans (FFS).
Dental PPO plans are indemnity insurance combined with a network under contract to the insurance company. Members can choose any dentist, with in-network dentists usually the most cost-effective choice.
Dental HMO plans provide contracted dentists a capitation fee for each patient that has been assigned to the dentist. Members must receive treatment at the in-network dentist.
Many seniors find the dental PPO plans more suitable if they’ve been accustomed to a PPO plan prior to age 65 and they are reluctant to change dentists. Seniors typically have long-standing relationships with their dentists; the NADP reports that 27% of those in the 65+ age group have been with their dentist for 11 to 20 years. Dental HMO plans are generally less expensive than dental PPO plans. But HMO networks often have a smaller number of dentists.
The relatively low premiums for dental insurance often help seniors save money in the long run. Through routine preventive care, they may avoid more serious and costly oral health issues. Plus, having dental insurance can help take the sting out of high-cost procedures that can be financially painful to someone on a retirement budget.
Discount or FFS dental plans are often marketed to seniors; however these plans are not true coverage. Instead they typically state the maximum the plan will pay for a given procedure or offers a discount percentage off the procedure price. Not all dentists accept discount cards.
Brokers who talk to their clients about post-retirement planning need to include dental coverage in the equation. Many dental plans may have waiting periods for some services. A broker who helps a retiree sign up for a senior dental plan can do them a big favor by helping them keep their mouths and bodies healthier.
The following are some key elements for seniors to consider in a dental plan:
• Emphasis on low-cost diagnostic and preventive care. Many dental plans have no co-payment for in-network services like exams, x-rays, and cleanings.
• Screening for oral cancer.
• A third teeth cleaning per year. Many plans offer enhanced benefits for seniors’ periodontal care, to keep gum disease at bay and reduce the risk of contracting diseases associated with it.
• Broad provider network for convenient access to their dentist.
• Affordable premiums.
• Easy-to-use and understand, so retirees are encouraged to seek the care they need.
• Excellent customer service so it’s easy to enroll, pay premiums and get questions answered quickly.
• Online quoting and enrollment tools to help them quickly and conveniently compare plans and get the coverage they need.
While not every senior will buy dental insurance, every one of them is likely to need dental care during their retirement years. This market segment represents an added opportunity to build your business. q
––––––––––Patrice P. Bergman, CEBS is the director of sales and product strategy for Specialty Benefits at Blue Shield of California, a not-for-profit health plan dedicated to providing Californians with access to high-quality care at an affordable price. Ms. Bergman can be contacted at patrice.bergman@blueshieldca.com. For more information, visit www.blueshieldca.com.